Meconium peritonitis

Meconium peritonitis is an unusual and often fatal form of neonatal peritonitis characterized by intraperitoneal calcification, numerous fibrosis with or without pseudocyst formation due to antenatal extravasation of meconium. This report is a retrospective study of 32 pediatric patients who were treated at the Surgical Department of the Children's Hospital from 1987 to 1996. The purposes of this study emphasize clinical manifestations, radiological findings, operative procedures and results of treatment. Twenty seven were neonates and five were older infants. The most common clinical presentation was abdominal distension at birth. The abdominal X-rays showed abnormal calcification and mass lesion in the peritoneal cavity in 71.9 and 46.9 per cent respectively. Only one patient was not treated surgically because he had no evidence of gut obstruction and inflammation. Thirty-one patients were operated on. At laparotomy, all of them had numerous inflammatory adhesion bands and matted bowel loops. Giant pseudocysts and intestinal perforations were noted in 64.5 and 54.8 per cent respectively. The obvious causes of meconium peritonitis were ileal atresia in 4, jejunal atresia in 3 and appendiceal perforation in 1. In the other 23 patients, no apparent cause of perforation was noted. Only lysis of the adhesion with or without drainage was done in 9 patients and one of these died. Partial resection of pseudocysts and exteriorization of the perforated bowel were done in 10 patients and 2 of these babies died. Primary anastomosis after resection of the perforated bowel was done in 12 patients and 5 of these cases died. The overall survival rate was 75 per cent. Our data from this study suggested that partial resection of the pseudocyst and temporary enterostomy should be done in cases with bowel perforation and severe meconium contamination. Early diagnosis, proper operative procedure and meticulous postoperative care offer the best opportunity for survival of patients with meconium peritonitis.